Early screening, management may prevent progression of liver diseases
An active screening programme managed by general practitioners (GPs) can help detect liver diseases at an early stage and may prevent further progression of liver diseases, says Dato’ Dr Mahendra Raj, a consultant gastroenterologist and hepatologist.
There is a whole spectrum of liver diseases—including nonalcoholic fatty liver disease (NAFLD)—this is where the liver enzymes are raised in patients who are overweight and may have a tendency to have diabetes or prediabetes, he said.
“The initial screening [for NAFLD] has to be done at the primary care level [among middle-aged patients] because a vast majority of these patients don’t have symptoms. They are only detected because routine blood tests pick up the abnormalities in liver function tests,” he said.
Similarly, patients in the early stages of chronic hepatitis B infection don’t have any symptoms so again an active screening programme by GPs which includes blood tests and physical examination may detect a large group of patients. This is important because these patients can then be treated and managed in the long term to prevent progression of this disease to cirrhosis or liver failure, said Mahendra.
In addition, some patients may present with symptoms and a somewhat more advanced stage of liver disease. They may have nonspecific symptoms such as tiredness and loss of appetite. If they have more severe disease or complications, they may have symptoms such as jaundice and hematemesis. It is crucial to screen for complications at an early stage to prevent disease progression.
If liver diseases progressed unchecked and unmanaged, these patients have the potential to develop advanced disease and liver failure. Patients who develop liver failure—the advancement of which cannot be controlled—will require liver transplantation, said Mahendra.
Another relatively smaller group of patients who require liver transplantation are those with acute liver failure. These patients who were previously healthy, become unwell due to a liver ailment, which presents suddenly causing them to deteriorate rapidly. These patients constitute an important segment of the population which, ideally, require a liver transplantation very soon, he said.
Only a fraction of those patients who die from liver disease may have survived after receiving a liver transplant because many patients die due to liver cancer, said Professor Mohamed Rela, chairman and director, Institute of Liver Disease and Transplantation, Gleneagles Global Hospitals, Chennai, India.
“When we diagnose cancers in the liver, probably only around 10 to 15 percent present at a stage where they are transplantable. [Liver transplantation] cannot be done for patients with advanced cancer for short-term survival. We have responsibility in choosing the right kind of patients for at least the possibility of good long-term survival,” said Mohamed.
“In general terms, we say if a patient won’t have at least 50 percent chances of living for 5 years, they are not candidates for transplantation. This is the general indication for distribution of organs,” he added.
Mahendra and Mohamed were speaking at the launch of the Pantai Gleneagles Global liver programme recently. Under this programme, patients with suspected liver diseases are referred to Hospital Pantai Kuala Lumpur (PHKL). Those who require liver transplantation are moved to Gleneagles Global Hospitals in Chennai followed by post care treatment back at PHKL.
Two public hospitals—Selayang Hospital and University Malaya Medical Centre—are already performing liver transplantations and growing with their experience. “The Pantai Gleneagles Global liver programme in no way undermines that. We are giving an additional option for patients. As the facilities and opportunities grow in Malaysia, then perhaps the majority of transplants will be undertaken in Malaysia,” said Mahendra.